References of "Damas, Pierre"
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See detailBronchoalveolar lavage fluids of patients with lung injury activate the transcription factor nuclear factor-kappa beta in an alveolar cell line
Nys, Monique ULg; Deby-Dupont, G.; Habraken, Yvette ULg et al

in Clinical Science (2002), 103(6), 577-585

In bronchoalveolar lavage (BAL) fluid from ventilated patients, cytotoxic oxidant activity is correlated with neutrophil activation. The aim of the present study was to investigate the hypothesis that BAL ... [more ▼]

In bronchoalveolar lavage (BAL) fluid from ventilated patients, cytotoxic oxidant activity is correlated with neutrophil activation. The aim of the present study was to investigate the hypothesis that BAL fluid induces activation of the transcription nuclear factor-kappaB (NF-kappaB) in human alveolar cells, in correlation with inflammatory mediators. We measured endotoxin, inflammatory cytokines [Interleukin-1beta (IL-1beta), IL-8], nitrated proteins and the activity of myeloperoxidase (MPO) in BAL fluid from ventilated patients developing bronchopneumonia (n = 19 samples) or with acute respiratory distress syndrome (ARDS) (n = 14), and from ARDS/infection-free patients (n = 11). We also exposed alveolar cells to the BAL fluid or to human MPO, H2O2 or HOCl, and tested nuclear extracts for the activation of NF-kappaB. IL-1beta, IL-8, nitrated protein, MPO and endotoxin levels were significantly higher in BAL fluid from patients with bronchopneumonia than in that from the ARDS and ARDS/infection-free groups. A correlation was observed between IL-8 and MPO values (r = 0.82). The level of NF-kappaB activity induced by the BAL fluid was correlated with levels of IL-1beta (P < 0.001), IL-8 (P < 0.005) and MPO (P < 0.002), and with the neutrophil count (P < 0.002), and was higher for BAL fluid from the bronchopneumonia group. NF-kappaB activation by MPO was also demonstrated. The activation of NF-kappaB by BAL fluid, especially that from bronchopneumonia patients, suggests that a similar phenomenon may occur in vivo, leading to potential amplification of the inflammatory reaction. [less ▲]

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See detailBrain function in the vegetative state
Laureys, Steven ULg; Antoine, S.; Boly, Mélanie ULg et al

in Acta Neurologica Belgica (2002), 102(4), 177-185

Positron emission tomography (PET) techniques represent a useful tool to better understand the residual brain function in vegetative state patients. It has been shown that overall cerebral metabolic rates ... [more ▼]

Positron emission tomography (PET) techniques represent a useful tool to better understand the residual brain function in vegetative state patients. It has been shown that overall cerebral metabolic rates for glucose are massively reduced in this condition. However, the recovery of consciousness from vegetative state is not always associated with substantial changes in global metabolism. This finding led us to hypothesize that some vegetative patients are unconscious not just because of a global loss of neuronal function, but rather due to an altered activity in some critical brain regions and to the abolished functional connections between them. We used voxel-based Statistical Parametric Mapping (SPM) approaches to characterize the functional neuroanatomy of the vegetative state. The most dysfunctional brain regions were bilateral frontal and parieto-temporal associative cortices. Despite the metabolic impairment, external stimulation still induced a significant neuronal activation (i.e., change in blood flow) in vegetative patients as shown by both auditory click stimuli and noxious somatosensory stimuli. However this activation was limited to primary cortices and dissociated from higher-order associative cortices, thought to be necessary for conscious perception. Finally, we demonstrated that vegetative patients have impaired functional connections between distant cortical areas and between the thalami and the cortex and, more importantly, that recovery of consciousness is paralleled by a restoration of this cortico-thalamo-cortical interaction. [less ▲]

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See detailCortical processing of noxious somatosensory stimuli in the persistent vegetative state
Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg; Peigneux, Philippe ULg et al

in NeuroImage (2002), 17(2), 732-741

The persistent vegetative state (PVS) is a devastating medical condition characterized by preserved wakefulness contrasting with absent voluntary interaction with the environment. We used positron ... [more ▼]

The persistent vegetative state (PVS) is a devastating medical condition characterized by preserved wakefulness contrasting with absent voluntary interaction with the environment. We used positron emission tomography to assess the central processing of noxious somatosensory stimuli in the PVS. Changes in regional cerebral blood flow were measured during high-intensity electrical stimulation of the median nerve compared with rest in 15 nonsedated patients and in 15 healthy controls. Evoked potentials were recorded simultaneously. The stimuli were experienced as highly unpleasant to painful in controls. Brain glucose metabolism was also studied with [F-18]fluorodeoxyglucose in resting conditions. In PVS patients, overall cerebral metabolism was 40% of normal values. Nevertheless, noxious somatosensory stimulation-activated midbrain, contralateral thalamus, and primary somatosensory cortex in each and every PVS patient, even in the absence of detectable cortical evoked potentials. Secondary somatosensory, bilateral insular, posterior parietal, and anterior cingulate cortices did not show activation in any patient. Moreover, in PVS patients, the activated primary somatosensory cortex was functionally disconnected from secondary somatosensory, bilateral posterior parietal, premotor, polysensory superior temporal, and prefrontal cortices. In conclusion, somatosensory stimulation of PVS patients, at intensities that elicited pain in controls, resulted in increased neuronal activity in primary somatosensory cortex, even if resting brain metabolism was severely impaired. However, this activation of primary cortex seems to be isolated and dissociated from higher-order associative cortices. (C) 2002 Elsevier Science (USA). [less ▲]

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See detailRecurrent fatal drug-induced toxic epidermal necrolysis (Lyell's syndrome) after putative beta-lactam cross-reactivity: Case report and scrutiny of antibiotic imputability.
Paquet, Philippe ULg; Jacob, Eric; Damas, Pierre ULg et al

in Critical Care Medicine (2002), 30(11), 2580-3

OBJECTIVE: A series of antibiotics may be responsible for toxic epidermal necrolysis. We report two successive episodes of toxic epidermal necrolysis in the same patient. Drug imputability criteria ... [more ▼]

OBJECTIVE: A series of antibiotics may be responsible for toxic epidermal necrolysis. We report two successive episodes of toxic epidermal necrolysis in the same patient. Drug imputability criteria designate a cross-reactivity between two antibiotics of different chemical classes but sharing the beta-lactam ring in common. DESIGN: Descriptive case report and review of the literature. SETTING: Medical intensive care unit in a university medical center. PATIENT AND MAIN RESULTS: A 75-yr-old woman developed a first episode of toxic epidermal necrolysis (involving 40% of the body surface) after intake of cefotaxime, a third-generation cephalosporin. Perfusions of high-dose immunoglobulins rapidly improved the lesions, followed by partial reepithelialization in 5 days. Sepsis required the administration of meropenem, which is a carbapenem antibiotic. The epidermal destruction immediately recurred, with extension to previously uninvolved skin areas and fatal consequences. CONCLUSIONS: The beta-lactam ring present in cephalosporins and carbapenems represents the putative chemical structure responsible for the presently reported cross-reactivity to two antibiotics of different classes. Drugs having any chemical similarity to the initial culprit compound should be strictly avoided when possible in the management of toxic epidermal necrolysis. [less ▲]

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See detailIncreased matrix metalloproteinase-3 serum levels in rheumatic diseases: relationship with synovitis and steroid treatment
Ribbens, Clio ULg; Martin y Porras, M.; Franchimont, N. et al

in Annals of the Rheumatic Diseases (2002), 61(2), 161-166

OBJECTIVE: To determine matrix metalloproteinase-3 (MMP-3) serum levels in patients with rheumatic diseases and to study the relation between MMP-3 and C reactive protein (CRP) levels. METHODS: MMP-3 ... [more ▼]

OBJECTIVE: To determine matrix metalloproteinase-3 (MMP-3) serum levels in patients with rheumatic diseases and to study the relation between MMP-3 and C reactive protein (CRP) levels. METHODS: MMP-3 serum levels were determined by enzyme linked immunosorbent assay (ELISA) in (a) patients with active inflammatory rheumatic diseases: rheumatoid arthritis (RA), psoriatic arthritis, polymyalgia rheumatica, acute crystal arthritis, and ankylosing spondylitis; (b) patients with active inflammatory systemic diseases: cutaneo-articular or renal systemic lupus erythematosus (SLE), systemic sclerosis, and vasculitides; (c) patients with non-inflammatory rheumatic diseases: osteoarthritis and fibromyalgia; (d) critically ill patients without rheumatic diseases, representing an acute inflammatory control group; (e) healthy controls. RESULTS: MMP-3 serum levels were significantly increased in patients with active RA, psoriatic arthritis, and polymyalgia rheumatica, whether treated or not by corticosteroids, and in female patients with acute crystal arthritis. MMP-3 serum levels were normal in steroid-free patients with active cutaneo-articular or renal SLE, systemic sclerosis, and vasculitides but were significantly increased in steroid treated patients. MMP-3 levels were normal in fibromyalgia, osteoarthritis, ankylosing spondylitis, and acute inflammatory controls. MMP-3 was significantly correlated with CRP in RA (r=0.5, p=0.0004) but not in any of the other disease groups. CONCLUSIONS: MMP-3 serum levels are increased in inflammatory rheumatic diseases characterised by joint synovitis, such as RA, polymyalgia rheumatica, psoriatic arthritis, and acute crystal arthritis-that is, whether the diseases are acute or chronic, erosive or not. They are normal in SLE, systemic sclerosis, and vasculitides as well as in non-rheumatic inflammatory controls, but are significantly increased by steroids. These data strongly suggest that serum MMP-3 reflects synovial inflammation. [less ▲]

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See detailLe deficit en alpha-1 antitrypsine. Une indication de transplantation hepatique pediatrique
De Roover, Arnaud ULg; Detry, Olivier ULg; Honore, Pierre ULg et al

in Revue Médicale de Liège (2001), 56(11), 753-8

Alpha-1-antitrypsin deficiency is the most common inborn error of metabolism leading to liver transplantation, and the second cause of liver transplantation in children after biliary atresia. The authors ... [more ▼]

Alpha-1-antitrypsin deficiency is the most common inborn error of metabolism leading to liver transplantation, and the second cause of liver transplantation in children after biliary atresia. The authors report the case of a 6-year-old girl, who was suffering from end-stage liver disease secondary to alpha-1-antitrypsin deficiency. She was successfully treated by whole liver transplantation, the hepatic graft coming from a 3-year-old donor. Three months later she went back to school. The authors discuss the pathogenesis and the natural history of this frequent cause of liver transplantation in children. [less ▲]

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See detailLe cas clinique du mois. Epidermolyse staphylococcique aigue chez une quinquagenaire
Fumal, I.; Paquet, Philippe ULg; JACOB, ERIC et al

in Revue Médicale de Liège (2001), 56(11), 745-747

Staphylococcal scalded skin syndrome is a bullous disease induced by bacterial exfoliative exotoxins. Children are most often affected. The prognosis is worse in adults and calls for treatment in an ... [more ▼]

Staphylococcal scalded skin syndrome is a bullous disease induced by bacterial exfoliative exotoxins. Children are most often affected. The prognosis is worse in adults and calls for treatment in an intensive care unit. We report a case in a quinquagenerian woman who suffered from angina a few days before the bullous erythroderma. [less ▲]

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See detailLe cas clinique du mois. Syndrome dyskinetique majeur induit par la ranitidine
Fouddah, A.; Canivet, Jean-Luc ULg; Damas, Pierre ULg

in Revue Médicale de Liège (2001), 56(8), 548-551

We report a case of severe dyskinetic syndrome, consisting of intense myoclonia movements, associated with choreiform activity involving the face and upper extremities. The abnormal movements occurred in ... [more ▼]

We report a case of severe dyskinetic syndrome, consisting of intense myoclonia movements, associated with choreiform activity involving the face and upper extremities. The abnormal movements occurred in a patient with confusion and visual hallucinations. This syndrome had an abrupt onset in a patient recovering from coronary artery bypass surgery complicated by an early post-operative cardiac arrest and acute renal failure. Dyskinesia appeared several days after intravenous administration of ranitidine for stress ulcer prophylaxis. Several etiologies were raised in this case among which were post-anoxic myoclonia and metabolic encephalopathy. Cessation of histamine receptor blocker therapy for 48 hours was associated with return of normal cognitive function and disappearance of abnormal movements. This confirmed the iatrogenic nature of the syndrome related to administration of ranitidine. [less ▲]

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See detailLiver transplantation in Jehovah's witnesses
Detry, Olivier ULg; Honoré, Pierre ULg; De Roover, Arnaud ULg et al

in Acta Gastro-Enterologica Belgica (2001, January), 64(1), 53

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See detailIntérêt de la procalcitonine dans le diagnostic des broncho-pneumonies liées au respirateur
Dubois, E.; Nys, N.; Ledoux, L. et al

Poster (2001, January)

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See detailLa fin de la vie en médecine intensive
Ferdinande, P.; Berré, J.; Colardyn, F. et al

in Réanimation (2001), 10

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See detailEtudes par tomographie à émission de positons chez des patients en coma, en état végétatif ou de conscience minimale, en «locked-in syndrome» et en mort cérébrale
Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg; Berre, Jacques et al

in L'évaluation neurophysiologique des comas, de la mort encéphalique et des états végétatifs (2001)

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See detailTreatment of drug-induced toxic epidermal necrolysis (Lyell’s syndrome) with intravenous human immunoglobulins
Paquet, Philippe ULg; Jacob, Emilie ULg; Damas, Pierre ULg et al

in Burns : Journal of the International Society for Burn Injuries (2001), 27(6), 652-655

Toxic epidermal necrolysis (TEN) is a rare drug-induced life-threatening disease. Currently, the disease is only treated by supportive and antiseptic measures. Quite recently intravenous immunoglobulins ... [more ▼]

Toxic epidermal necrolysis (TEN) is a rare drug-induced life-threatening disease. Currently, the disease is only treated by supportive and antiseptic measures. Quite recently intravenous immunoglobulins (IG) were shown to be a promising TEN treatment. The rationale for their use is based on the fact that keratinocyte apoptosis in TEN involves the CD95 (APO-1/Fas) cell surface receptor–ligand system. We successfully treated a TEN patient with high dose of intravenous IG. The clinical recovery appeared exceptionally rapid. Immunohistochemistry showed that the IG action probably developed on the CD95 receptor–ligand system at the keratinocytes surface. [less ▲]

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See detailRandomized, placebo-controlled trial of the anti-tumor necrosis factor antibody fragment afelimomab in hyperinflammatory response during severe sepsis: The RAMSES Study
Reinhart, Konrad; Menges, Thilo; Gardlund, Bengt et al

in Critical Care Medicine (2001), 29(4), 765-769

Objective: This study investigated whether treatment with the anti-tumor necrosis factor-a monoclonal antibody afelimomab would improve survival in septic patients with serum interleukin (IL)-6 ... [more ▼]

Objective: This study investigated whether treatment with the anti-tumor necrosis factor-a monoclonal antibody afelimomab would improve survival in septic patients with serum interleukin (IL)-6 concentrations of >1000 pg/mL. Design: Multicenter, double-blind, randomized, placebo-controlled study. Setting: Eighty-four intensive care units in academic medical centers in Europe and Israel. Patients: A total of 944 septic patients were screened and stratified by the results of a rapid qualitative immunostrip test for serum IL-6 concentrations. Patients with a positive test kit result indicating IL-6 concentrations of >1000 pg/mL were randomized to receive either afelimomab (n 5 224) or placebo (n 5 222). Patients with a negative IL-6 test (n 5 498) were not randomized and were followed up for 28 days. Interventions: Treatment consisted of 15-min infusions of 1 mg/kg afelimomab or matching placebo every 8 hrs for 3 days. Standard surgical and intensive care therapy was otherwise delivered. Measurements and Main Results: The study was terminated prematurely after an interim analysis estimated that the primary efficacy end points would not be met. The 28-day mortality rate in the nonrandomized patients (39.6%, 197 of 498) was significantly lower (p < .001) than that found in the randomized patients (55.8%, 249 of 446). The mortality rates in the IL-6 test kit positive patients randomized to afelimomab and placebo were similar, 54.0% (121 of 224) vs. 57.7% (128 of 222), respectively. Treatment with afelimomab was not associated with any particular adverse events. Conclusions: The IL-6 immunostrip test identified two distinct sepsis populations with significantly different mortality rates. A small (3.7%) absolute reduction in mortality rate was found in the afelimomab-treated patients. The treatment difference did not reach statistical significance. [less ▲]

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See detailEuthanasia: a law in Belgium?
Damas, François ULg; Damas, Pierre ULg; Lamy, Maurice ULg

in Intensive Care Medicine (2001), 27(10), 1683

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See detailRelationship between procalcitonin plasma level and severity of infection
Servais, P.; Nys, Monique ULg; Canivet, Jean-Luc ULg et al

in Intensive Care Medicine (2001), 27(suppl.), 560

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See detailCorrelation between endotoxin level and bacterial count in bronchoalveolar lavage fluid of ventilated patients
Nys, Monique ULg; Ledoux, Didier ULg; Damas, Pierre ULg et al

in Critical Care Medicine (2000), 28(8), 2825-2830

OBJECTIVE: To assess the predictive value of the endotoxin level in the bronchoalveolar lavage (BAL) and to propose to the clinician a guide in the diagnosis of gram-negative bacterial (GNB) pneumonia ... [more ▼]

OBJECTIVE: To assess the predictive value of the endotoxin level in the bronchoalveolar lavage (BAL) and to propose to the clinician a guide in the diagnosis of gram-negative bacterial (GNB) pneumonia. DESIGN: Retrospective and prospective studies to investigate the relation between endotoxin level and quantitative bacterial culture of BAL and to test the predictive value of a defined threshold. SETTING: University hospital general intensive care unit. PATIENTS: In the first part of the study, 77 consecutive ventilated patients with clinical suspicion of nosocomial pneumonia between January 1995 and January 1996. In the second part of the study, 93 consecutive ventilated patients studied prospectively between February 1996 and April 1997. MEASUREMENTS AND MAIN RESULTS: Quantitative cultures for aerobic bacteria were performed directly from the fluid. Bacterial species were determined with standard techniques. The detection of endotoxin in BAL was made using a quantitative chromogenic Limulus assay. In the retrospective analysis, a significant correlation between quantitative GNB cultures and BAL endotoxin levels was observed (r2 = 0.60, p < .0001). An endotoxin level > or = 4 endotoxin units/mL (EU/mL) distinguishes patients with a significant GNB count from colonized patients with a sensitivity of 92.6%, a specificity of 81.4% and a correct classification rate of 84.9%. In the prospective analysis, the 4 EU/mL threshold permits identification of infected patients with a sensitivity of 82.2%, a specificity of 95.6%, and a correct classification rate of 90.3%. The receiver operating characteristic curve analysis showed that the Limulus assay still had a good discrimination power in the prediction of significant bacterial count in BAL fluid. CONCLUSIONS: Endotoxin detection immediately after bronchoscopy is a distinct advantage to the clinician because antimicrobial gram-negative therapy may be immediately justified according to the results. [less ▲]

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